| (a) Designated doctor narrative
reports must be filed in the form and manner required by the division
and at a minimum:
(1) identify the question(s)
the division ordered to be addressed by the designated doctor examination;
(2) provide a clearly
defined answer for each question to be addressed by the designated
doctor examination and only for each of those questions;
(3) sufficiently explain
how the designated doctor determined the answer to each question within
a reasonable degree of medical probability;
(4) demonstrate, as appropriate,
application or consideration of the American Medical Association Guides
to the Evaluation of Permanent Impairment, division-adopted return-to-work
and treatment guidelines, and other evidence-based medicine, if available;
(5) include general information
regarding the identity of the designated doctor, injured employee,
employer, treating doctor, and insurance carrier;
(6) state the date of
the examination and the address where the examination took place;
(7) summarize any additional
testing conducted or referrals made as part of the evaluation, including
the identity of any health care providers to which the designated
doctor referred the injured employee under §127.10(c) of this
title (relating to General Procedures for Designated Doctor Examinations),
the types of tests conducted or referrals made and the dates the testing
or referral examinations occurred, and explain why the testing or
referral was necessary to resolve a question at issue in the examination;
(8) include a narrative
description of the medical history, physical examination, and medical
decision making performed by the designated doctor, including the
time the designated doctor began taking the medical history of the
injured employee, physically examining the employee, and engaging
in medical decision making and the time the designated doctor completed
these tasks;
(9) list the specific
medical records or other documents the designated doctor reviewed
as part of the evaluation, including the dates of those documents
and which, if any, medical records were provided by the injured employee;
(10) be signed by the
designated doctor who performed the examination;
(11) include a statement
that there is no known disqualifying association as described in §127.140
of this title (relating to Disqualifying Associations) between the
designated doctor and the injured employee, the injured employee's
treating doctor, the insurance carrier, the insurance carrier's certified
workers' compensation health care network, or a network established
under Chapter 504, Labor Code;
(12) certify the date
that the report was sent to all recipients required by and in the
manner required by §127.10 of this title; and
(13) indicate on the
report that the designated doctor reviewed and approved the final
version of the report.
(b) Designated doctors who perform examinations under §127.10(d)
or (e) of this title shall also complete and file the division forms
required by those subsections with their narrative reports. Designated
doctors shall complete and file these forms in the manner required
by applicable division rules.
(c) Designated doctors who perform examinations under §127.10(f)
of this title must, in addition to filing a narrative report that
complies with subsection (a) of this section, also file a Designated
Doctor Examination Data Report in the form and manner required by
the Division. A Designated Doctor Examination Data Report must:
(1) include general information regarding the identity
of the designated doctor, injured employee, insurance carrier, as
well as the identity of the certified workers' compensation health
care network under Chapter 1305, Insurance Code, if applicable, or
whether the injured employee is receiving medical benefits through
a political subdivision health care plan under Labor Code §504.053(b)(2)
and the identity of that plan, if applicable;
(2) identify the question(s) the division ordered to
be addressed by the designated doctor examination;
(3) provide a clearly defined answer for each question
to be addressed by the designated doctor examination and only for
each of those questions. For extent of injury examinations, the designated
doctor should also provide, for informational purposes only, a diagnosis
code for each disputed injury;
(4) state the date of the examination, the time the
examination began, and the address where the examination took place;
(5) list any additional testing conducted or referrals
made as part of the evaluation, including the identity of any health
care providers to which the designated doctor referred the injured
employee under §127.10(c) of this title, the types of tests conducted
or referrals made and the dates the testing or referral examinations
occurred;
(6) be signed by the designated doctor who performed
the examination.
(d) This section will become effective on December
6, 2018.
|
